Special hospital
FILIP V TORI
www.cardiosurgery.com.mk; +389 2 3091- 484
CENTER FOR STROKE PREVENTION AND THERAPY 222
INTRODUCTION Stroke is the second most common cause of death in the world. Incidence has approximately 780,000 new cases in the USA, and according to the World Health Organization, yearly 15 million people worldwide are affected by stroke or the annual incidence is 25 per 100,000 residents. Mortality in the USA is 168,538 people per year. There are two types of strokes – first type is ishaemia, when there is occlusion and embolization of the brain blood vessels, and second is hemorrhage, when there is rupture of the blood vessel. Frequency of ischaemic stroke is 60% , the one of transitory ischaemic attacks 30% and 10% of haemorragical attacks. In particular, brain thrombosis is the result of creation of ateromatosus plaques in the blood vessels, lumen narrowing with reduced blood flow and oxygen, or coagulopathies which lead to the creation of thrombus in brain blood vessels. Risk factors are: increased cholesterol, diabetes mellitus, hypertension, hereditary factors, stress, smoking and other. Therefore, education of patients and physicians for early detection of CHADS C. Fresh cardiac disorders H. Hypertension А. Age D. Diabetes Ѕ . Previous stroke or ТIA Total results СНАDЅ - results 0 1
patients at risk is of particular interest for prevention. There is s.c Risk scoring system for stroke, which should be assessed for each patient. According to Table 1, depending on СНАDЅ –results, patients with atriall fibrillation should be given appropriate therapy for prevention of stroke. PREVENTION Primary prevention • • • • • •
Blood pressure measurement Regulation of cholesterol Regulation of glucemy Diet (healthy food) Physical activity Avoiding alcohol and smoking
Secondary prevention • Atriall fibrillation treatment – warfarin • Anticoagulant and antiagregational (aspirin and clopidogrel) • Avoiding of smoking and alcohol • Treatment of HTA and HLM • Carotidal endarcterectomy • Carotidal stent • Rehabilitation (physical therapy, occupational therapy, speech therapy, neuropsychologist) Results 1 1 1 1 1 2
Recommendations for treatment Aspirin Aspirin or Varfarin (INR2/3)
DIAGNOSIS Special hospital „FILIP VTORI“ has most modern equipment for diagnosis of strokes: ECG, ECHO, carotid doppler, 64 MCKTof brain with angiography Multidisciplinary team of cardio surgeons, cardiologists, neurologists, psychologists, physiotherapists. According to the recommendations of the British Association of Physicians, the American Association for Heart Disease (Committee recommendation for stroke), the guides include the following diagnostic methods: • Laboratory blood examination • ECG, ECHO of carotids and heart • Carotid imaging • КТМ, НМР
STROKE THERAPY According to the recommendations of the American Academy of Neurologists (AAN) and AHA (American Heart Association), pa-
tients in the Center for stroke diagnosis and treatment in „FILIP VTORI“ are treated as follows and with the following therapy: • Urgent accommodation in an Intensive Care Unit and half intensive treatment; • TPA or warfarin therapy; • Anticoagulant and thrombolytic therapy; • Oxygenation; • Tromboectomy -angioplasticsendarcterectomy (in patients with carotidal disease and indication for this type of intervention); According to recent studies by European cardio-surgeons from London, indications for alternative stent of carotides are very limited; • Physical therapy and early rehabilitation; • Neuropsychological therapy; Thus, only in this hospital with European standards, patients with stroke can receive a complete and modern rapid diagnosis and adequate treatment by a multidisciplinary team of experts.
Sp ec ia l hos p it a l
F ILIP V TO R I
www.cardiosurgery.com.mk; +389 2 3091- 484